Trump Rolls Back Obama's Birth Control Coverage Rule

Now any woman’s boss can object to covering contraception on moral grounds.

NEW YORK ― President Donald Trump's administration issued a new rule Friday that allows all employers to opt out of including birth control in their health insurance plans for any moral or religious reason, rolling back the Obama-era requirement that guaranteed contraception coverage at no cost to 62 million women.

Requiring insurance plans to cover birth control imposes a "substantial burden" to the free exercise of religion guaranteed by the U.S. Constitution, and could promote "risky sexual behavior" among adolescents, the administration told reporters Thursday night.

The Affordable Care Act deemed contraception an essential part of women's preventive health care for the first time in history, requiring that it be covered under most insurance plans, along with prenatal care, breast exams and well-woman visits. The birth control mandate compelled for-profit employers to cover the full range of contraceptives, including the pill, the intrauterine device and the Plan B morning-after pill, at no out-of-pocket cost to women, while carving out exemptions for churches and nonprofit religious organizations.

The Trump administration, which is stacked with officials who oppose contraception, will now allow any employer or for-profit company, regardless of whether they are religious, to refuse to include the coverage in their health insurance plans for moral reasons. This could mean that tens of thousands to hundreds of thousands of women in the United States will once again have to pay out of pocket for birth control.

"I think what the Trump administration is trying to do is effectively gut the rule without repealing it, because repealing it would be so unpopular," said Gretchen Borchelt, vice president for reproductive rights and health at the National Women's Law Center. "They're taking contraception coverage away from women without justification."

Women's health groups have argued that the policy, crafted and supported by anti-abortion activists, will have the opposite of its intended effect. Before the law took effect in 2012, one in three women struggled to afford her birth control prescription each month, which can cost up to $50 a pack for the pill and much more for long-acting methods like the IUD. And more than 20 percent of women of childbearing age had to pay for contraception out of pocket. The preventive health benefit saved women $1.4 billion on birth control in the first year it went into effect, which has contributed to an all-time low in unintended pregnancy and the lowest U.S. abortion rate since the procedure became legal in 1973.

Many religious conservatives who oppose birth control coverage believe some forms of contraception, including the IUD and the morning-after pill, are akin to abortion. According to a report by the left-leaning think tank the Center for American Progress, 45 companies have applied for exemptions to the birth control rule, more than half of which are for-profit companies. Trump's much broader loophole would allow any boss to object to the coverage.

The Becket Fund for Religious Liberty, a legal advocacy group that has fought the contraception mandate in court on behalf of nonprofits, praised Trump's new workaround.

"We believe that people with sincere religious beliefs should be able to use an exemption," said Lori Windham, an attorney with the group. "It's a good way to protect those Americans who want to be able to provide quality health insurance, but can't in good conscience provide contraceptives."

Several progressive legal groups, including the National Women's Law Center and the American Civil Liberties Union, have indicated that they will challenge the move. The Supreme Court told the Obama administration in April 2016 that it must find a way to accommodate religious employers while also guaranteeing that women continue to receive full and equal contraception coverage, regardless of where they work. Trump's rule does nothing to guarantee women seamless coverage.

The groups could also challenge the new regulation on the grounds that it discriminates against women by singling out a women's health benefit.

"It violates equal protection laws if they are treating women differently," said Borchelt. "We're outlining a number of potential legal claims, and we have some really good, strong complaints."